Heel pain or plantar fasciitis

Healing your heel pain

Heel pain is common and results in millions of GP appointments worldwide. Symptoms can be seen in all types of people, both the sedentary and overweight, as well as the fit and active. The symptoms are often persistent and can result in a significant impact on your quality of life.

At Schoen Clinic, we offer you rapid diagnosis and the latest evidence-based care to relieve heel pain and restore your mobility.

What is plantar fascia?

Plantar fascia is a thick ligament that is attached to the bottom of the heel bone (calcaneus) and connects this to the ball of the foot. Its function is to help with the propulsion of the foot through a windlass action across the arch of the foot.

Symptoms indicating plantar fasciitis

Heel pain on weight-bearing is the main symptom. The location of the pain may vary slightly between individuals but typically the origin of the plantar fascia on the inner aspect of the bottom of the heel bone is the focus of the pain. Pain is typically worse after a period of rest and disuse. Typically, the first few steps out of bed in the mornings can be the worst, this is because the calf muscle tightens up when resting, so it may take a little while for things to stretch out in the morning. Swelling may occur but this would be an unusual symptom, and if there is significant swelling then an alternative diagnosis may be the culprit. Whatever the condition,  our specialists will determine the cause via an accurate diagnosis.

Plantar fasciitis: The most common cause of heel pain

There are a number of risk factors for the development of the condition. The most important predisposing factor is having tight calves. It is also seen in those with very high or even very low arches. Overuse activities such as running or occupations that involve prolonged standing or walking are also known to predispose you to the condition. Having a high body mass index has also been linked to developing the condition. Occasionally the symptoms can start after a single traumatic event such as a fall from height.

Diagnosis: X-rays may be recommeended to check for heel spurs

Heel spurs are bony calcium deposits underneath the heel bone and close to the origin of the plantar fascia. There has been much debate as to the relevance of these in relation to plantar fasciitis. What is clear, however, is that there are many people with heel spurs who have no pain, and many with pain but no heel spurs. Removal of heel spurs, therefore, is not recommended in the treatment of heel pain.

Plantar fasciitis or heel pain: Surgery is always the last resort

The bad news is that there is not a single simple cure for plantar fasciitis. The good news is that there are many treatments available that can improve your symptoms. At Schoen Clinic, our specialists are experts in managing this condition, and a multidisciplinary team of surgeons and therapists are at your disposal to manage your heel pain.

Plantar fasciitis or heel pain treatment without surgery

Rest - this should be the first step in managing an acutely painful heel. For example, if running is the cause of your heel pain then stopping or reducing the amount you run should be the first step.

Physiotherapy - stretching and strengthening exercises of the calf muscle (gastrocnemius), the hamstrings, the hip and core muscles as well as specific plantar fascia rehabilitation can help ease symptoms.

Insoles or orthotics - depending on your foot shape and arch height, we may recommend specific insoles or footwear for you.

Night splints - if early morning pain is a major problem then sleeping with a splint which keeps your foot in an upward position can be very helpful. There are many types available but a Strasbourg sock is a simple one that most patients find easy to use.

Shockwave therapy - mechanical shocks applied to the painful area over a number of spread-out sessions can be a very helpful modality with a good body of evidence behind it.

Injections - there are various injectables that can be considered such as cortisone (a type of steroid) or PRP (platelet-rich plasma) that can be used.

We will carefully assess your individual condition and symptoms to see if you are suitable for any of these treatments.

Plantar fasciitis or heel pain surgery only when necessary

If your symptoms have failed to ease with non-surgical treatment and you have had severe pain for many months or even years then we may recommend surgery. There are various surgical interventions available. Our preferred method is to release or lengthen the calf muscle through a small incision on the inside of your leg. We have had good success in treating recalcitrant cases of heel pain and our lead foot and ankle surgeon, Mr Ali Abbasian, has published on this technique and is nationally recognised for it. 

Heel pain: Our foot specialists

The aim of our specialists is to provide you with the best course of action following an accurate diagnosis. Our data driven approach to quality outcomes ensures that you get the best possible result from your treatment and a positive improvement in your quality of life.

Heel pain: Our specialised hospital

From rapid diagnosis to treatment and aftercare, we have everything you need to resolve your heel pain at Schoen Clinic. Based in the heart of London, our specialist hospital has state-of-the-art imaging, treatment rooms, surgical theatres, physiotherapy and luxury patient rooms spread across 7 floors, all dedicated to providing the quality care and best possible outcomes we are renowned for.